Ms Paula Hilman:

I thank the Chairman and committee members for the invitation to address them today in respect of the discussions on the Mental Health Bill. I am here as I was the project sponsor for the CAST project under A Policing Service for the Future. I am accompanied by Chief Superintendent Derek Smart, who will be able to outline our operational experience since the pilot went live in Limerick in January 2025. The initiative is being trialled in partnership with the HSE and, as I outlined with the chief being here, in the Limerick Garda division. It is aimed at assisting people who are experiencing situational trauma or a mental health crisis. The initial project under A Policing Service for the Future was called crisis intervention teams but, as we developed the project, we adapted the name, and our pilot name, CAST, stand for community access support team. Its central goal is to reduce future presentations and interactions with gardaí or other blue light emergency services through community follow-ups and case management of complex cases. CAST has yet to be evaluated not only in terms of impact on individuals but also on the amount of Garda time being devoted to an area, some of which is not a core function of An Garda Síochána.

It is important to note that, since its introduction, CAST has created greater integration among statutory and voluntary agencies operating in the Limerick Garda division. It is grounded in international evidence and research showing that co-response has delivered improved outcomes for adults requiring intervention at times of mental health crisis or situational trauma. It also serves to implement recommendations contained within a range of interdepartmental Government reports and policies. The result, in our view, is a project that can guide national policy on mental health service delivery through knowledge and learning.

The team consists of three HSE staff, namely, a clinical nurse specialist, a social worker and a senior social care practitioner, and three gardaí, who work side by side from Henry Street Garda station in Limerick. They are further supported by an additional 50 gardaí who have completed co-responder specialist training and clinical HSE staff. The co-response is initiated by the CAST service which responds to appropriate calls. Trained gardaí, supported by the clinical HSE staff, provide an intervention and assessment, leading to a better outcome for persons involved.

The early outcomes and available data are encouraging and have seen more than 40 diversions from arrest and detentions under section 12 of the Mental Health Act 2001. That is since the pilot went live in January - more than 40 diversions in one division. A further consequence of this would have seen an admission to an emergency department and medical call-outs. CAST has recorded more than 1,700 operational hours of service in its first four months of operation and has seen more than 150 individuals interact with the project.

The second pillar of the project is the CAST forum. I have talked about the reactive calls and response to calls. The CAST forum clients are subject to levels of interagency work not witnessed in this jurisdiction previously. We currently have 11 persons registered for the forum, with 12 partner agencies involved. That is about prevention and putting interventions in place to prevent people engaging with both gardaí and blue light services. The scope of the delivery under the project has widened both in terms of the numbers of callbacks -142 in total - and outreach providing earlier intervention based on needs. An evaluation report being undertaken by the University of Limerick’s school of nursing will inform and ultimately decide the future implementation of the CAST model, but it has received wide cross-agency support.

Based on our experiences with CAST, An Garda Síochána would like to highlight some areas for consideration by the committee in its consideration of the Mental Health Bill 2024, specifically on involuntary admission. The Bill in its current form appears to be dependent on the availability of authorised officers. It is the experience of our CAST team that there is a need for a 24-hour, 7-day-a-week service to support delivery in this area. While the proposed measure under the Bill is intended to enhance clinical oversight and safeguard individual rights, in practice, it is our view this will introduce significant delays and inefficiencies unless a significant number of out-of-hours authorised officers are installed. We further contend that only allowing authorised officers to make an application could add to the already adversarial and structured process and potentially cause significant delays to a person receiving treatment. It would also generate knock-on delays in emergency departments and Garda stations, depending on where a person presents. An Garda Síochána is supportive of the Bill’s objectives to achieve the least restrictive intervention, and this aligns to the ethos behind CAST. It is worth noting, however, that the change in criteria for involuntary admission to the point where someone presents as an immediate risk may also make it more likely that they will be subjected to more restrictive practices.

A significant finding under CAST has been a concerning gap in service for individuals, who, following a detention under the Mental Health Act, receive a letter or advice to attend an approved centre such as a psychiatric hospital or emergency department. The person is not obliged to attend and, in practice, we have seen many individuals in acute psychological crisis simply walk away once released by gardaí, without ever engaging with services. To help bridge this gap, CAST has implemented a structured call-back protocol, providing follow-up contact with individuals after their release, checking on well-being and assessing ongoing risk, and we attempt to re-engage them with services. While this offers some assurance and has yielded significant results - 142 call-backs - it is not, in our opinion, a substitute for legislative authority.

While CAST is in its infancy, it speaks to the commitments in the programme for Government and represents interagency collaboration in its purest form. The area of crisis presentations is incredibly complex and we recognise it is vital to build in protections and safeguards through the new Bill. I thank the committee for allowing us the time to outline that.